Do I need to undergo thyroid scan?

Q:I am a 33 years old female suffering from hypothyroidism, which was detected very late. In my first report, TSH level was approx 78 & has started taking medicines but still having constipation problem. After sometime, I started having high pulse rate (i.e. mostly above 100). For the last three years, the doctors have tried to find out reason for high pulse rate but mere unsuccessful. I was even hospitalised for five days for investigation because my heart beat was more than 150. I have the these symptoms - feel very weak, constipated, cold and cough, burning sensation, hair loss, exhausted very quickly, heaviness in chest, bodyache etc. I did not have any health related problem earlier and even my doctors have told me that I am not having any heart related problem. My heart specialist asked me to undergo thyroid scan to find out if I had infection in thyroid gland but the doctor who was treating me refused to do thyroid scan. Many a times, my ESR level is high & once a doctor told me that high pulse rate might be due to infection also. Do I need to undergo thyroid scan? In my recent report, ESR is 25 and TSH is 12.38. High TSH shows that I should increase the dose of thyroid tablet. Right now I am taking thyronorm (50 mcg) for two days and 25 mcg on the third day. If I increase dose I feel very uneasy & again my pulse goes higher. According to a doctor my thyroid dose is OK she says sometimes TSH also goes high because of infection. We do not have any thyroid history in the family but now my brother is also suffering the same and his report showed TSH level of approx 300.

A:No doubt you have hypothyroidism but we need to find out the cause. Simple test to do so will be anti-TPO or FNAC from thyroid gland if enlarged. Thyroid scan is unlikely to give answers to your queries. Thyroid scan is useful for patients having thyrotoxicosis or multinodular goitre.In management of hypothyroidism, first step is to make TSH normal and after normal TSH if some symptoms persist then we need to find the cause by doing more tests. I suggest you to increase the dose of thyronorm to 50 a day and repeat TSH after 6 weeks. To avoid palpitation you may take thyronorm 2 hours after dinner as well. It is possible that you have other endocrine deficiency such as cortisol but this can be investigated only after TSH becomes normal.